What Depression Really is...

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27 Jun 2011 (updated 4 Sep 19 )

In Depressed ISN'T Sad, I talked about how the vagueness of the meaning of the word 'depressed' creates problems when friends and family try to cheer us up.

I separated out two ideas where 'depressed' means sad versus 'Depressed' being the medical condition.

It turns out that friends and family aren't the only ones who are confused. Depressed persons run into EXACTLY the same problems – we don’t properly understand what Depression is, so we misunderstand the critical problems, and we then apply the wrong solutions to coping with Depression.

Although Depression covers a lot of territory and has lots of symptoms, over the years I’ve realised that the defining features of Depression are

  1. the Inability to Focus, and
  2. the Inability to Get Things Done.
  3. Generalised Anxiety about everything and nothing

Being Depressed is about Productivity. Or rather, the lack of it.

Why Productivity and Anxiety? Why not Feelings?

Depression anxiety is pretty awful. It can include anxiety about every little thing, panic attacks where you feel your heart beating so fast and your muscles are all clenched, the fear of dealing with anybody, from your boss to your mother to the person selling you croissants. This is a true symptom of Depression which I deal with below in the section below on Generalised Anxiety about Everything and Nothing.

However, the generalised anxiety can can expand to include feelings such as the loss of self worth, the sense that you are no good for your partner, the sense that you will never achieve anything and you are of no value to anyone, the sense that you will fail at everything forever and that you are better off giving up, the sense you are an utter failure, and that you should perhaps hide under the bed, or any of the other 18 symptoms of Depression.

Yes, I do get all those thoughts, these feelings that I can't carry on, or that I am a failure, or that no one can possibly love me, or that I'm worthless and everything I touch will turn to dust.

But I've learned, slowly and with effort over the last decade, that I can monitor for thoughts of lack of self worth and that I can discard these thoughts when I get them. It's not easy, but it's possible.

How I do it is that I compare what I am thinking to what I remember my reality to be like the last time I was not depressed. If there's a mismatch, then I trust how I felt when I was not depressed and discard how I'm feeling now. And while this can be learned, it is NOT so easy to learn. Two steps forward, one step backward and all that. And that wonderful saving phrase - "This too shall pass."

To recap, I’m not saying that the symptoms about feelings are nice or easy to cope with or easily solvable, or the problems they cause are insignificant, because they’re not. But they don’t bubble up to the top as the critical symptoms of Depression.

Back to Productivity

Unlike the thoughts of Depression, I can't get around the loss of productivity. And when I say loss of productivity, I mean the complete loss of productivity. So, not able to complete any tasks at work, can't make the calls to colleagues, can't go to the grocery, can't take out garbage, can't do any cleaning in the house, can't call my friends or family, can't shave. Can't write for my website, can't study, can't do research, can't make it out of the house to go to the cinema.

Can't even reach out for help or explain to my partner what is going wrong.


Now everything doesn't fail at once. What happens is that tasks fail progressively over the course of time until nothing is working. So you go through mild depression to bad depression to severe depression. Sometimes to very severe depression.

You might notice that it's only after productivity starts falling that all of the other issues start becoming problems (except for anxiety, see below). If you check the 18 Symptoms of Depression, you'll notice that failing productivity is the START of the depression episode.

Since I have a fast mood swing cycle, the onset of depression from mild to severe is usually about 2-3 days (for most people it will probably be longer, sometimes measured in weeks).

And annoyingly these days, at age 45, I can stay in severe depression for a week or two. If that doesn't sound so bad, imagine sitting at home doing exactly nothing for two weeks. And nothing includes not talking to other people. Or going to work. Or anywhere.

For all of us, bad depression severely disrupts any kind of life you have. So severely that productivity drops to exactly zero.

Well...when I'm badly depressed, I still manage to feed the dogs. Though since they can get fed anywhere between 5 pm to about 1 am, it's not exactly the most splendid show of productivity. And it's the only productive thing I'll do for the entire day.

Most importantly, unlike the depression related feelings, I can't set the lack of productivity aside and move on. If your illness stops you from doing things, then you can't do something about it because you can't, well, DO things.

See the problem?

Yes, in time the depression ends and I start doing things again, but during the depression episode, I do nothing for a week or two.

Dealing with Productivity is the Most Critical Thing

Here’s why.

If you can Focus and if you can Get Things Done, even a little, then regardless of how tiny the task, you’ll feel as if you have some control over your life. And success encourages success. You’ll feel that maybe slowly and eventually, small step by small step, you’ll get your work or tasks or social activities done, and you’ll eventually get to where you want to be. It's something to look forward to.

But if you can’t Get Things Done…well, you feel helpless because you won’t get around to doing anything or you’ll start then stop halfway. And nothing will get finished. And you stay feeling helpless - in fact it's worse than before because now you know that you can't get anything done. It’s a terrible terrible feeling.

That’s why I put the ability to Focus and the ability to Get Things Done as the most critical problems of Depression, and the ones to fix first.

Generalised Anxiety about Everything and Nothing

In the section above on Why Productivity and Anxiety? Why not Feelings?, I've already spoken about how Feelings can be examined and set aside. However, generalised anxiety is a special thing. As far as I can tell, generalised anxiety is a direct part of Depression itself - not a secondary effect or symptom, but one of the actual features of Depression.

I'm still trying (as at 4 Sep 19) to understand where this comes from, but my current solution is to take Rivotril / Clonazepam to ease the generalised anxiety, even though it seems to have no effect on the pattern of either my Depression or Mania episodes (I still get them). The Rivotril makes me calmer, allows me to focus better and get a bit more done, and allows me to deal with people better.

So if this is what Depression is, what do I do to stop it from happening?

I'm not sure you can stop Depression episodes from happening. Or at least not all the time. But here are some things that you should be doing to help you either avoid a Depression or minimise the problems it causes you and your family and friends.

  1. Set up a Set up a Mood Chart so you can track how you are feeling and how you are acting. The link describes the process of setting up and using a mood chart, as well as Mood Chart Scales you can use.
  2. Check out I'm Getting Depressed. What do I Do? to get a feel of how to handle an oncoming Depression episode to see if you can stave it off.
  3. If you do realise you are Depressed, check the link I'm Depressed. What do I Do Now? to see what you can do, without feeling guilty about doing it.
  4. Take the medications that your psychiatrist gave you. Not happy about taking meds? - read this article on Why you should Take the prescribed Meds.

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Can't comment here on Google Sites, but you can Email Me at livingmanicdepressivemail@gmail.com

Old Wordpress Comments

Jul 6, 2011 : jinnahJames,Got your scale. I would like to add it to the blog, and shortly thereafter to my website, but I need to now how you would appreciate my giving credit for it.I can (a) Add a byline saying “provided by James Littiebrant” with no link. (b) As above, but add a hyperlink to your webpage / twitter account / facebook account. (c) Have nothing on the blog / website, but keep the information about you in an invisible comment in the HTML source code. (d) Add a byline saying “provided by a reader to the website” with no information about you anywhere. (e) Not bother and just accept it as a free contribution to my website / blog with no byline at all. (f) Any other idea you may have.Note that for both (d) and (e), I would be able to track down that you did provide it to me since I archive all my e-mails (I am obsessive about some things, but that’s because I’m a crazy person). But I won’t necessarily be reminded each time I review or re-edit the page.Thanks, by the way.Cheers.jinnah

Jul 6, 2011 : James Littiebrant : twitter.com/LittieCheeseI set it up on a five point scale:1-Persistently fighting with people in my head. Favors are annoyances, any discussion I can’t control is infuriating. Any road bump in a task makes me drop the entire thing. Constant feeling of lashing out or breaking things. Small ticks in people’s behavior infuriates me. No patience. Control is nearly impossible.2-Prickly. Favors require compensation. Feel the need to pick fights with people or to bring them down. Occasional feelings of lashing out. Most things are frustrating, but I persist in tasks. Small ticks in people’s behaviors irritate me. Very little patience with delays. Control is possible, but requires constant monitoring.3-Normal, can control anger. People’s ticks are just a part of everyday life4-Easy going. I don’t fight with people in my head. Slights and ticks are part of everyday life and make people unique. Favors are appreciated, and I feel fine in both doing them and asking for them. No need to control anger. May have some righteous indignation, but nothing irrational. Plentiful patience.5-Cannot become irritated or annoyed at anything. Passive and feeling perfectly calm. Not even righteous indignation at events. Everything seems explainable and normal. Patience with everything.Since I use it as a predictive measurement, I focus more on the phenomenology of agitation. But agitation is also a head game you play with yourself, so it works to some extent in labeling your actual agitation levels. The 4 and 5 levels for tracking drugs like xanax so I can pin down just what those drugs are actually doing to my mind.James

Jul 5, 2011 : jinnahJames,If your agitation/irritability scale has explanations of what the numbers mean, could you send me a copy please. Wouldn’t mind adding it to the collection of scales we can use. I like the google docs spreadsheet as well, and the info via phone? Whoa, more tech savvy than I am! I still use pen and paper.Thanks for your comments.jinnah

Jul 5, 2011 : James Littiebrant : twitter.com/LittieCheeseI like the new scale and how detailed it breaks down every aspect of what moods can do to your everyday abilities. I use a modified version of your old scale to include agitation/irritability along with anxiety. Agitation makes me gauge how much interaction I should have and whether I should stay away from other people so I don’t inadvertently offend them or blow up at them for no reason.
It also makes me take a step back and think about the fights I have with people in my head and helps me look at it objectively.
Anxiety can also be huge if you have mania. Sometimes I slip into a hyperactive paranoid anxiety fest that also crushes productivity since all I can think about is some conspiracy theory (although at the time I usually think I am productive, but I can fill in the details after the fact). So for those with BP1, adding these scales might also help predict where your moods are and where they might be going since these symptoms might come before a full mania.
I’ve also put it into a google docs spreadsheet form. They have a form function, so I just tick off the numbers and I can easily make a chart so I can track the direction of my moods more easily as well as provide hourly updates from my phone since I can cycle within a day. So more tech savvy people might like it. Plus, ticking off numbers on a form is somehow easier to do when I’m depressed and don’t feel like doing anything.
Just some thoughts on how I’ve updated your system, love the new one though, especially its focus on objective behaviors rather than feels.James
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